PCV < 0.35 l / l (< 35 %)
Determine if anemia is regenerative
Nucleated RBC
Note: Size and colour differences (anisocytosis & polychromasia)
Note: Normal erythrocyte morphology
Howell-Jolly bodies
REGENERATIVE ANEMIA
NON-REGENERATIVE ANEMIA
NO
Reticulocyte count > 60,000/µl? Increased MCV, MCHC or RDW? Anisocytosis, polychromasia? Increased nRBC? Increased H-J bodies?
YES
History or clinical evidence of blood loss? (Consider hematemesis, melena or hematochezia, epistaxis, internal hemorrhage). Low to low-normal total solids/protein or albumin/globulin?
NO
WBC and platelets: i f normal, sign for extramedullary disease, e.g. chronic renal disease, inflammation, endocrinopathy if low, consider bone marrow disease, e.g. infectious disease such as EHRLICHIOSIS, LEISH MANIOSIS; drugs; neoplasia; myelodysplasia
YES
Rule out hookworm & other GI parasites, GI ulceration and neoplasia, coagulopathy, thrombocytopenia, trauma and internal bleeding.
Regenerative anemia without evidence of blood loss is consistent with HEMOLYSIS (immune, infectious, hereditary, toxic, microangiopathic, metabolic).
Schistocyte
50.0 µm
ANEMIA
20.0 µm
The Anemic Dog
LOOK FOR BLOOD PARASITES
Agglutination
Spherocytes
SCHISTOCYTES (DAMAGED RBC)
SPHEROCYTES & AGGLUTINATION
HEINZ BODIES – OXIDATIVE INJURY
Rule out: micro- and mac roangiopathy: neoplasia (hemangiosarcoma), DIC, vasculitis, dirofilariasis (caval syndrome)
Rule out: IMHA, blood parasites and other underlying causes (neoplasia)
Rule out: toxicities – onion & garlic, zinc, paracetamol (acetaminophen), copper (New Methylene Blue stain)
The Diagnostic Paths were developed with support of Prof. Peter Irwin, Murdoch University, Australia; Prof. Sathaporn Jittapalapong, Kasetsart University Thailand; Prof. SungShik Shin, Chonnam National University, Korea and Prof. Barbara Kohn, Free University of Berlin, Germany.
BLOOD PARASITES Rule out: Babesiosis, Ehrlichiosis, Anaplasmosis; Hepatozoonosis, Dirofilariasis, Hemotropic Mycoplasma